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Key points

  • We recommend to consult your poison centre when considering the use of these chelating agents.
  • Acute exposure to heavy metals can lead to life-threatening clinical manifestations (e.g., lead encephalopathy).
  • Administration of a chelating agent within 2 hours or less may be indicated after the diagnosis of acute heavy metal poisoning is made. 
  • Heavy metals serum concentrations are available through specialized laboratories.
  • This monograph lists chelating agents and only provides information on their most common indications, routes of administration, availability, and recommended stocking levels. 
  • For any additional information, such as dosing recommendations, adverse effects, monitoring and endpoints of treatment, consult your poison centre.

+ Synonyms and other terms

  • Dimercaprol; British anti-Lewisite; BAL; BAL in oil
  • Dimaval; Unithiol, 2,3 dimercapto-1-propaone sulfonate; DMPS; 2,3-dimercaptopropanesulfonic acid
  • Edetate calcium disodium; Calcium disodium edetate; Calcium disodium ethylenediaminetetraacetate; Calcium disodium EDTA; Calcium EDTA;  Sodium calcium edetate
    • NOTE: Do NOT confuse with Sodium EDTA; edetate sodium; tetrasodium ethylenediamine tetraacetate
  • Penicillamine; Cuprimine; D-penicillamine
  • Succimer; meso-2,3-Dimercaptosuccinic acid; DMSA; Chemet; Succicaptal

 

+ Indications

Listed below are the most common indications for each chelating agent. Note, some agents are also used to chelate other metals than those described below. Contact your poison centre for additional information.

  • Dimercaprol (BAL)
    • Arsenic, gold or mercury poisoning
    • Acute lead poisoning in combination with edetate calcium disodium.
  • Dimaval (DMPS)
    • Arsenic or mercury poisoning
  • Edetate calcium disodium
    • Acute lead poisoning in combination with dimercaprol
  • Penicillamine
    • Copper poisoning
  • Succimer (DMSA)
    • Lead poisoning

+ Dosage

Not available, contact your local poison centre for more information.

 

+ Monitoring

Not available, contact your local poison centre for more information.

 

+ End of treatment

Not available, contact your local poison centre for more information.

 

+ Special Notes on Administration

  • Dimercaprol (BAL)
    • IM administration
  • Dimaval (DMPS)
    • IV administration
  • Edetate calcium disodium
    • IM or IV administration
  • Penicillamine
    • PO (oral) administration
  • Succimer (DMSA)
    • PO (oral) administration

+ Available products

  • Dimercaprol (BAL)
    • No longer licensed for use in Canada (Cancelled Post Market)
  • Dimaval (DMPS)
    • Dimaval injection 250mg/5mL (sodium content per vial : 1.2 mmol (27.4mg))
    • Health Canada special access program = yes
      • Heltex corporation 
        • Phone number : 1-855-439-5839 or +49 (30) 8 16 96-0
        • Fax : 1-855-937-9377
        • Email: vertrieb@heyl-berlin.de
  • Edetate calcium disodium
    • Edetate calcium disodium 5%, 50mg/mL, Inj, 10 mL ampule 
    • Health Canada special access program  = yes
      • SERB Laboratories
        • Phone: 011-33-1-73-03-20-00
        • Fax : 011-33-1-46-36-75-47
  • Penicillamine    
    • Cuprimine capsule 250mg, DIN 00016055
    • Health Canada special access program = no, McKesson = yes
  • Succimer (DMSA)
    • Chemet, 100mg capsule
      • Recordati Rare Disease
        • Phone: 1-908-236-0888
        • Fax: 1-908-236-0028
    • Succicaptal, 200mg capsule
      • Serb laboratories
        • Phone: 011-33-1-73-03-20-00
        • Fax : 011-33-1-46-36-75-47
    • Health Canada special access program = yes

+ Amount required to treat a person weighting 70kg during 24 hours

  • Dimercaprol (BAL) : Not applicable (no longer marketed in Canada)
  • Dimaval (DMPS) : 2100 mg
  • Edetate calcium disodium : 4000 mg
  • Penicillamine : 2000 mg
  • Succimer (DMSA) : 2100 mg

     

Last updated : 2022-06-23